Alexander J. Chien, MD, Jon A. Jacobson, MD, David A. Jamadar, MB,BS, FRCS, FRCR, Monica Kalume Brigido, MD, John E. Femino, MD and Curtis W. Hayes, MD
1 From the Department of Radiology, Pomona Valley Hospital and Medical Center, Pomona, Calif (A.J.C.); the Departments of Radiology (J.A.J., D.A.J., M.K.B.) and Orthopaedic Surgery (J.E.F.), University of Michigan Medical Center, 1500 E Medical Center Dr, TC-2910G, Ann Arbor, MI 48109-0329; and the Department of Radiology, Medical College of Virginia/Virginia Commonwealth University, Richmond, Virginia (C.W.H.). Received September 4, 2004; revision requested December 11 and received February 23, 2004; accepted March 8. Address correspondence to J.A.J. (e-mail: firstname.lastname@example.org).
Six patients were retrospectively identified as having undergone lateral ligament reconstruction surgery. The surgical procedures were categorized into four groups: direct lateral ligament repair, peroneus brevis tendon rerouting, peroneus brevis tendon loop, and peroneus brevis tendon split and rerouting. At radiography and magnetic resonance (MR) imaging, the presence of one or more suture anchors in the region of the anterior talofibular ligament indicates direct ligament repair, whereas a fibular tunnel indicates peroneus brevis tendon rerouting or loop. Both ultrasonography (US) and MR imaging demonstrate rerouted tendons as part of lateral ankle reconstruction; however, MR imaging can also depict the rerouted tendon within an osseous tunnel if present, especially if T1-weighted sequences are used. Artifact from suture material may obscure the tendon at MR imaging but not at US. With both modalities, the integrity of the rerouted peroneus brevis tendon is best evaluated by following the tendon proximally from its distal attachment site, which typically remains unchanged. The rerouted tendon or portion of the tendon can then be traced proximally to its reattachment site. Familiarity with the surgical procedures most commonly used for lateral ankle ligament reconstruction, and with the imaging features of these procedures, is essential for avoiding diagnostic pitfalls and ensuring accurate assessment of the ligament reconstruction.